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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adequate Insurance.

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Strategy. EPSDT

Approach. Expand access to EPSDT benefits for children enrolled in Medicaid

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Overview. Early and Periodic Screening, Diagnostic, and Treatment. (EPSDT) is a federally mandated benefit that every state Medicaid program must provide to children, birth to age 21, who are enrolled in Medicaid. Many Medicaid and Title V programs work in partnership to ensure children have access to EPSDT.[1]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Boston University's Catalyst Center Financing Strategies Database

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of Medicaid-enrolled children who receive information about EPSDT benefits and how to access services. (Measures outreach efforts to promote awareness and utilization)
  • Number of healthcare providers trained on EPSDT requirements and best practices for delivering comprehensive screenings and follow-up care. (Assesses workforce capacity building)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of Medicaid-enrolled children who receive at least one EPSDT screening per year. (Measures the program's success in engaging eligible children in preventive care)
  • Percent of EPSDT screenings that include all required components according to federal and state guidelines. (Assesses adherence to comprehensive screening standards)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of community-based organizations engaged to promote EPSDT and assist with scheduling and transportation for appointments. (Expands outreach and support beyond the healthcare system)
  • Number of family input sessions for advisory councils held to gather feedback on EPSDT services and inform program improvements. (Demonstrates commitment to family partnership and engagement)

OUTCOME MEASURES:

  • Number of school days attended by children who receive timely diagnosis and treatment of health conditions through EPSDT. (Shows the program's impact on reducing health-related absenteeism)
  • Number of children who receive case management and care coordination to address complex needs identified through EPSDT screenings. (Measures the program's impact on integrating and personalizing care)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of Medicaid-enrolled children under age 21 who have access to EPSDT services. (Assesses the program's reach and potential to benefit the entire eligible population)
  • Percent of EPSDT services provided in community-based and non-traditional settings (e.g., schools, mobile clinics). (Shows efforts to improve usability and convenience for families)

OUTCOME MEASURES:

  • Percent of children who receive regular EPSDT screenings and are up to date on immunizations and preventive care. (Shows the program's impact on key child health metrics)
  • Percent increase in the number of children who receive early intervention and are on track for healthy development. (Reflects the program's ultimate impact on child well-being and school readiness)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. EPSDT Financing Strategy.
https://ciswh.org/project/the-catalyst-center/financing-strategy/epsdt/

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.